Karyotype of a female with Trisomy 21 (NDSS 2012)
Every child is unique, therefore every child presents differently. However, some of the classic musculoskeletal signs of Down Syndrome that tend to affect their gross motor development includes poor muscle tone (hypotonia), loose joints (ligamentous laxity), and atlanto-axial instability (AAI).
The goals of PT for these kiddos are not necessarily to accelerate the development of a gross motor skill, but to minimize the development of compensatory movement patterns. (Winders 2001). Due to their low muscle tone and their loose joints, many of them often figure out other ways to access their environment. As physical therapists, we want to facilitate a life long love for movement! By teaching them correct movement patterns, we can minimize future injury, improve their strength and balance, so they can access their environment in the best way they can!
According to Patricia Winders, PT, Physical Therapy services should:
- Be concerned with the kiddo's long-term function
- Seek to minimize the development of compensatory movement patterns
- Be based on a thorough understanding of the compensatory movement patterns that children with Down Syndrome are prone to developing
- Be strategically designed to build strength in the appropriate muscle groups so that they will develop optimal movement patterns
- Focus on gait, posture and exercise.
- Decreased ability to generalize. This means that a skill learned in one setting does not necessarily transfer to another setting. For instance, they may do an awesome job climbing the stairs at home, but when confronted with stairs elsewhere, they may regress to a more primitive stair-climbing strategy until they have relearned the skill in the new setting.
- Deliver information in small bite-sized pieces. If a child appears to have plateaued with a skill, the problem is most likely because the next piece of information is too large and needs to be further broken down.
- Structure, consistency and a familiar environment. This is so important if you hope to get the best performance. Do not try something new or challenging when the child is tired, hungry or not at his best for some reason. Minimize distractions for the environment. Remember, quality over quantity!
- Follow the child's lead. They must be motivated to perform a particular skill. Try to model your style of interaction after the parents' style, since it is familiar to the child and most likely to be successful.
- Know when to quit. Some will only give you two repetitions at a particular skill and then insist on moving on. Other children will gladly give you a dozen repetitions. Set up the game so that the child is successful and avoid frustration!
- Be strategic in planning your session. Practice what the child is ready to learn. Tackle the most difficult skills first before the child becomes tired. Alternate difficult tasks with easier ones to give the child time to recover their strength.
- Be strategic in providing support. Children with Down Syndrome may become quickly dependent on support. Provide as little support as possible while still allowing the child success and remove the support as soon as possible.
- Skills will be learned grossly at first and then refined. For example, children will initially learn to walk with a wide base and their feet externally rotated. While not an optimal gait pattern, it needs to be allowed initially and then refined through the post-walking skills.
- Do not interfere with an established skill in which the child has achieved independence. You will not be successful in introducing change and the child will only experience you as nagging. Change will need to be made at the next level of motor development. For instance, some children, instead of learning to creep on both kn earn to creep on one knee and one foot. Once this pattern has been established and the child is proficient in its use, you will not be successful in altering it and will succeed only in angering the child. Teach the child to use both knees in climbing up stairs rather than interfering with the established pattern.
- National Down Syndrome Society (NDSS) (2012). What is Down Syndrome? Retrieved from: http: //www.ndss.org/Down-Syndrome/ What-Is-Down-Syndrome/
- NDSC Statement On: Atlanto-axial Instability (1991). Position Statement on Atlanto-Axial Instability. Retrieved from: http://www.ndsccenter.org/wp-content/uploads/AtlantoAxial_Instability.pdf
- Winders, P.C. (2001). The goal and opportunity of physical therapy for children with Down syndrome. Down Syndrome Quarterly, 6(2), 1-5.
- Yoon, L. (2015). Down Syndrome [Powerpoint slides]. Retrieved from Columbia University Program in Physical Therapy.